Active NPI
Iraida Rivera
- Nurse Practitioner
- Santa Rosa, CA
National Provider Identifier
1730447970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95008058
- Practice address
- 3333 Chanate Rd
Santa Rosa, CA 95404-1707 - Phone
- (707) 565-4935
- NPI assigned
- Apr 25, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 796084 | CA | |
| Nurse Practitioner | 363L00000X | 95008058 | CA | Primary |
Addresses
Primary practice location
3333 Chanate Rd
Santa Rosa, CA 95404-1707
Mailing address
1523 Alhambra Ave
Martinez, CA 94553-2403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220504002901 | CA | Order and Referring Only - Nurse Practitioner | 5092102335 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 796084 | CA | MD | Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513555200000",
"number": "1730447970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1523 ALHAMBRA AVE",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945532403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 CHANATE RD",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954041707",
"telephone_number": "707-565-4935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "IRAIDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-25",
"last_updated": "2017-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "CA",
"license": "796084",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95008058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.